Hi,
These articles may be of interest to you. There is some information related to breast cancer patients within these general articles.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474153/
med.monash.edu.au/.../managing-your-menopause-after-breast-cancer.pdf
Each of you should discuss this with your own doctor, but many oncologists and even gynecologists are not that well informed about breast cancer and low dose vaginal estrogen, which I think is the most effective treatment for vaginal atrophy.
I have seen one article on the net that showed that after a few weeks, vaginal estrogen does not increase serum estrogen level beyond normal levels found in post-menopausal women.
http://www.ncbi.nlm.nih.gov/pubmed/8041532
This agrees with what my oncologist told me. Once the vaginal lining is thickened up by the estrogen, not enough escapes to the blood stream to cause a problem.
She had no problem with me using it, although my cancer was ER negative. It has helped me with vaginal atrophy using Ovestin (estriol 1mg/g) cream, 0.5g dose every second day, but I still have hot flashes all the time. The oncologist wasn't keen on it for ER pos patients.
This article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396801/ suggests it may be a problem for ladies on aromatase inhibitors (Arimidex and Femara) but it was a small study and the dose for the vaginal estrogen tablets was 25 micrograms (discontinued product) where as lower dose 10 micrograms tablets are now used.
Note: Tablets and rings deliver a more accurate dose than a cream.
There is not a lot of evidence around for breast cancer patients, but my thoughts are this:
If you had an ER neg tumor, use vaginal estrogen, as necessary. Ignore the warnings on the medication box insert.
If you had ER pos early breast cancer, the general articles given above suggest vaginal estrogen is OK if you are not on an aromatase inhibitor.
If you are on an AI, try the other methods such as Replens, then discuss carefully with your oncologist - if your symptoms are bad or your quality of life and relationships are disrupted, it may be worth the unquantified "risk" of using a low dose.
If you have ER pos mets, likely no doctor will prescribe estrogen in any form anyway.
These are my thoughts, anyway. I'd like to hear of any tips from those into alternative medicines also.
Aussie Girl